Biology is not destiny

Seeking a scientific explanation for trans identity could do more harm than good

Biology is not destiny

Seeking a scientific explanation for trans identity could do more harm than good

By Alex Barasch

June 27, 2018

Before “Love is love” became the rallying cry gracing protest signs and storefronts for Pride Month, the go-to gay slogan, by way of Lady Gaga, was “Born this way.” It was a succinct articulation of an argument some saw as essential to acceptance: Same-gender attraction was neither a choice nor a contagion, but rather an innate aspect of identity.

But this idea is not the straightforward civil rights argument its purveyors seem to believe it to be. Lesbian, gay, bisexual and transgender people have long been the victims of bad science, and President Trump’s military ban is just the latest example. The American Medical Association promptly debunked claims that trans people are unfit to serve and that gender dysphoria — the distress that arises from a perceived mismatch between a person’s natal sex and gender identity — cannot be alleviated with access to transition-related care. But more insidious invocations of medicine have continued to undermine trans rights: GOP lawmakers, for instance, cite the so-called American College of Pediatricians, an anti-LGBTQ hate group that attempts to pass itself off as the (gender-affirmative) American Academy of Pediatrics, to justify anti-trans “bathroom bills.”

In this climate, the rush to fight pseudoscience with real scientific results is understandable. A study published in Nature in January and a presentation at the European Congress of Endocrinology in May each pointed toward potential anatomical markers of transness. They sparked a flurryofarticles trumpeting a definitive “born this way” narrative and anticipating brain scans that “can tell kids if they’re transgender.” But this impulse to validate marginalized identities through medicine oversimplifies the science, overestimates its role in effecting social change and willfully ignores its more sinister applications. Even if a precise biological origin for same-gender attraction or trans identity could be found, it would be far from an assurance of equality — and opponents of LGBTQ rights could just as readily see it as a defect in need of correction.

Protesters gather at Columbus Circle in New York, across from the Trump International Hotel and Tower, in July 2017 after the administration’s decision to ban most transgender people from serving in the U.S. military. (Erik McGregor/Pacific Press/LightRocket/Getty Images)

For lesbian, gay, and bisexual individuals, the appeal to science has been understandable as a defense against more obviously damaging (and incorrect) explanations. As English professor Valerie Rohy explains in her book “Lost Causes,” biological determinism emerged in part as an answer to homophobic ideas about gay men and women falling prey to seductive cultural and communal forces. It was a response to the pervasive fear that gay parents or teachers might “contaminate” children who would otherwise be straight. The same fearmongering language is being used now in articles from publications such as the National Review and the Daily Mail that invoke the debunked science of “rapid onset gender dysphoria.” According to analysis from the Conversation, this approach purports that children “are being misled into claiming a trans identity before they truly understand what that means,” having supposedly been “influenced by the internet, social media and peers.”

To a certain extent, the evidence of a biological basis for sexuality — taken by many as proof that gay people are “born this way” as opposed to being converted by outside forces — has helped to stop the rhetoric of social contagion. But playing up this aspect of identity also reduces gayness to an anomaly, and as the search for a specific “gay gene” or region of the brain continues, we run the risk of finding it only to pathologize it.

This debate isn’t new for trans identities like mine, either. The first “landmark” studies on brain differences among gay vs. straight individuals and cis vs. trans individuals (where “cis” refers to anyone whose gender matches their sex assigned at birth) occurred within a few years of each other. In 1991, neuroscientist Simon LeVay conducted a postmortem analysis of the brains of 19 “homosexual” men (a category that included at least one bisexual man), 16 “presumed heterosexual” men (six of whom had AIDS-related deaths) and six “presumed heterosexual” women. Finding that the interstitial nucleus of the anterior hypothalamus (INAH 3) was twice as large in the second group as in the first, LeVay presented it as evidence of a fundamental difference between the brains of gay men and those of their straight counterparts.

With its inconsistent methodology, small sample sizes, lack of gay women and failure to account for the role of HIV/AIDS — which LeVay himself acknowledged as a shortcoming, and other researchers later hypothesized may have affected INAH 3 size among the “homosexual” men, all of whom had AIDS-related deaths — LeVay’s study offered a flawed and incomplete picture of human sexuality. Nonetheless, it was sensationalized by the press and celebrated by much of the community, as was Dick Swaab’s similar 1995 study on the brains of transgender women. Swaab found that among trans women (those who were assigned male at birth), a region of the brain that he deemed “essential for sexual behavior” was, on average, more similar to that of cisgender women than that of cis men. Transgender men were not included in the study, and again, the small sample sizes and postmortem nature of the analysis muddied the results. But if Swaab’s findings held true, they also raised questions that couldn’t be answered by the brains of deceased adults: For one, was the difference a cause of transness or a consequence of it?

This conflation of correlation and causation is particularly important because behavior and the environment are known to affect brain anatomy, which changes throughout an individual’s life. Observed disparities might, as the authors of the January paper in Nature acknowledged, “reflect the distress that accompanies gender dysphoria” — that is, the lived experiences of the trans women they studied, as opposed to an inborn “transgender trait.”

The other problems that marred LeVay’s and Swaab’s work haven’t gone away since the ’90s. FMRIs are expensive, so sample sizes are often small, reducing studies’ statistical power — and, by extension, their chances of detecting a true biological effect. The brain activity observed through such scans can also be difficult to interpret. A given region of the brain can be associated with any number of behaviors, so even well-meaning neuroscientists might see an area “light up” and might emerge with an explanation that fits their expectations. Most notoriously, one puckish researcher was able to produce evidence of neural activity in a dead salmon when he used it to test a new protocol. It’s a comical but ultimately cautionary tale — and a testament to the risk real neuroscientific studies run of misreading their findings.

These problems, less pressing when the subject is a dead fish, take on outsize importance when potentially flawed research is used to validate, medicalize or deny human identities. Attempts to dispel fears by way of etiology enshrine an imperfect science as the basis for our rights. Our society already polices access to gendered spaces and transition-related care, and the notion that someone might not be “trans enough” enables individuals and institutions to disregard those who don’t meet an arbitrary standard.

Gavin Grimm, a transgender teenager from Virginia, fought a legal battle to use the boys bathroom at his high school. This spring, he won his Supreme Court case. (Oliver Contreras/For The Washington Post)

The hunt for precise biological markers could radically alter people’s lives, especially if given such cultural currency — yet even trans-friendly outlets and journalists have been quick to make the jump from small-scale studies to the fantasy of brain scans that can reveal your gender. Julie Bakker, whose lecture at the European Congress of Endocrinology sparked conversations about such a diagnostic, pushes pushes back against this application of her research, though she understands the desire for an easy answer: “We work a lot with children and adolescents, and we had parents who were hoping that we could look into the brain of their son or daughter and say, ‘Okay, we can actually see that your son’s brain is not ‘male-like,’ so that’s explained.’ ” But, she told me, “it’s not going to work like that. There’s no such thing as a ‘100 percent male’ man or a ‘100 percent female’ woman — we all have some masculine or feminine traits.”

She used spatial ability — the capacity to understand and visualize objects’ relative positions, as demonstrated when, say, using a map to find your way across a city — as an example. “We know that men are overall, on average, better than women, but you can have a man who’s really terrible with this stuff, and you can have a woman who’s better than the average man.” The fact that these sex differences are neither pronounced nor wholly consistent highlights the problem of invoking such clear-cut dichotomies. Just as LeVay’s study grouped its lone bisexual subject with gay men, subsequent work has tended to ignore or miscategorize people whose gender or sexuality falls outside the more commonly understood (and perhaps methodologically neater) binary. Including such people as part of the wrong group may skew results. Eliding their very existence in the hope of arriving at a cleaner conclusion leaves them without answers of their own — and becomes even more problematic when science is treated as the best or only means of validating their identity.

Bakker, for her part, told me she had not worked with nonbinary people (those who do not identify as either male or female), in part because of sample size limitations. “Whenever you do fMRI research, you need to get at least 20 individuals, and you want to get more,” she explained. And, having been questioned about their identities ad infinitum in daily life, would-be subjects from the already small pool are understandably wary of participating: “It’s not like they’re jumping up and down to go and lie in your scan.”

The enduring burden of the medicalization of trans brains and bodies may also give candidates pause about walking into a lab to be analyzed further. People who seek to transition through hormones or surgery face gatekeeping at every turn, including psychological and medical evaluations in which the accepted manifestations of manhood or womanhood can be extremely narrow. As journalist Laurie Penny noted in her book “Meat Market: Female Flesh Under Capitalism,” one British psychiatrist has been known to refuse treatment to trans women who arrive at appointments in pants instead of a skirt. Trans men like me can be interrogated or turned away if they are sexually attracted to other men, as happened in Norway. In Bakker’s native Belgium, she says, it’s exceptionally difficult for trans people to access hormone therapy, and children are often sent to psychiatrists to be “cured” of their identity.

Bakker’s 2014 study looked at this younger population, analyzing children’s responses to the smell of androstadienone — a steroid that’s known to elicit different patterns of hypothalamic activity in adult men and women. Crucially, it’s an innate physiological response rather than a learned one, so gendered socialization couldn’t impact the results; the toys the kids had played with or what the adults in their lives expected of them wouldn’t alter their reaction to such a chemo-signal. The team found that adolescents with dysphoria responded in a way that reflected their experienced gender: Trans boys reacted the way cis boys do, and vice versa for trans girls.

Bakker hopes to increase acceptance through scientific understanding — but the unfortunate reality is that biological essentialism doesn’t always help the cause. In 2016, a survey by psychologist Patrick Grzanka and his team found that, while most people who were accepting of gay men believed that sexual minorities are “born this way,” those who were not accepting shared the same belief — meaning ideas about the “naturalness” of a person’s orientation don’t always predict tolerance. “Strategic essentialism,” as Grzanka calls it, may not be as constructive as many LGBTQ activists and advocates believe.

There are darker applications to consider, too, and researchers’ good intentions can’t absolve their work of its capacity to do harm in practice. Essentialism can be used by either side — as a fix for homophobia and transphobia, or as a means of pathologizing and othering the people oppressed by those forces. Before LeVay, there was Fritz Roeder and Dieter Müller’s mid-20th-century “stereotactic hypothalamotomy,” a “psychosurgery” in which the region of the brain thought to be responsible for gay men’s sexuality was removed or destroyed by an electronic probe. As Nancy Ordover recounts in “American Eugenics: Race, Queer Anatomy, and the Science of Nationalism,” the two considered their “cure” to be a matter of “public health policy,” and the practice was endorsed at the time by the Lancet, a leading medical journal, as an ethical alternative to castration. It continued in Germany and elsewhere through the 1970s.

Transgender actress Daniela Vega, at microphone, starred in “A Fantastic Woman,” which won the Oscar for best foreign-language film this year. The success helped Vega boost a gender-identity bill in Chile, her home country. (Pablo Vera /AFP/Getty Images)

Given the complexities of identifying and interpreting differences — and of preventing their weaponization — we should resist the impulse to base the legitimacy of trans identities on findings that could just as easily be used for gatekeeping or parsed as a disorder. The search for the “gay gene” has been long and, so far, inconclusive. Crucially, lesbian, gay and bisexual acceptance has moved forward without it. As Rohy puts it, the real role of civil rights and increasing representation in the culture is about “widening the space of possibility in which [queerness] becomes visible as a livable life.” It shows us ways of moving through the world we might not have imagined or understood to be accessible. To know that trans people exist and are increasingly able to do so happily will open doors for the next generation — those who, in decades past, might never have found a word for what they felt or the support they needed to improve their quality of life.

Taking LGB rights as a precedent, it seems that legal victories like Gavin Grimm’s Supreme Court case (in which the justices sided with the transgender teenager in his fight to use the boys bathroom at school) and social change sparked by positive representation in media will help in more concrete ways. When the Chilean drama “A Fantastic Woman” won an Oscar this year, the prestige allowed Daniela Vega, its transgender star, to revive a flagging gender-identity bill in her home country, bolstering support among progressive and conservative legislators alike. Simply seeing trans people fairly depicted goes a long way toward humanizing them — far more than being able to point to a specific part of the brain ever could or should.

With gender dysphoria no longer considered a mental illness by the World Health Organization, a long-awaited demedicalization of transness is underway. Now is the time to recognize that etiology does not always lead to equality. Like sexual identity, gender emerges from a host of factors, both biological and cultural. As such, affording fundamental rights and respect to all shouldn’t — and can’t — be contingent on any one explanation.

Both good science and good advocacy dictate that we’re better off acknowledging what we don’t know about ourselves than overstating what we do. It doesn’t help the LGBTQ community to pin our validity on what we might learn, if only we could scan the right brains or pinpoint the right genes — and if we trust the volume of the frontal cortex over what a person tells us about themselves, we deny them their autonomy and their humanity. Rather than waiting for firmer biological footing, those who really want to advance the cause should start by believing trans people when they speak up about who they are.